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Thursday, May 28, 2020

An Expert Explains: Lockdown-unlockdown debate

Faced with a pandemic as well as a struggling economy, policymakers are grappling with difficult choices on relaxing lockdown restrictions. Jaipur city’s nodal Covid officer describes the factors to be considered.

Written by Ajitabh Sharma | Updated: May 16, 2020 7:43:28 pm
Migrants board a truck to Chhattisgarh, Madhya Pradesh and Uttar Pradesh from the Pune-Ahmednagar highway at Pune’s Karadi on Thursday night. (Express Photo: Arul Horizon)

In the midst of the rising numbers of people getting infected and dying from the novel coronavirus, voices in favour of reopening social and economic activities are also becoming louder.

With the number of positive cases across the country having crossed 80,000, and with more than 2,600 people dead, policymakers are grappling with difficult choices. The economy is struggling on all fronts, from skyrocketing unemployment to nosediving financial resources, which are vital to jump-start economic activities.

The massive migration of labour, and the numbers of stranded people swarming the roads, will be one of the defining socio-economic events of our times — and governments face the challenge of responding simultaneously to great human misery and a risk-laden infection super-spreader event.

The question of whether the pandemic will scale down in the near future or not, has no definitive answer, and the closest one is, “It is not going to”. Which implies that one has to learn to live with it. Everyone has to also feel and act more responsible towards everyone else, and be more disciplined both socially and individually.

Responsibility and discipline will bring regulated restrictions in our daily lives, from social distancing, hygiene, and using masks to taking care of the elderly and those at high risk. The government, society, and our healthcare system will have to become more responsive.

The current debate on regulating the lockdown restrictions and its impact on the economy, lives and livelihoods, is not only going to occupy increasing public space, but is also set to become more argumentative as well as more objective.

Relaxing the lockdown without compromising the health security of people is going to become a daunting task for governments. But benchmarking of some critical parameters related to Covid management can show the way forward. It will assist decision-makers in bringing an element of flexibility — balancing the aspects of socio-economic needs and the health emergency.

The Government of India has prudently categorised districts into red, orange, and green zones based on demographic and disease prevalence-related details. States have to follow the directives of the Centre regarding the various activities permissible in different zones. The states are free to impose stricter restrictions, but not to relax the restrictions laid down by the Centre.

If the relaxing of the lockdown is considered as a ‘problem-solving exercise’, governments may work upon characterising the problem based on answering the following parametric questions, depending on which decisions may be taken:

– Is there a continuous decline in the rate of hospitalisation of Covid patients in the last 14 days (the incubation period of the virus)?

– Is there a continuous decline in the rate of deaths of Covid patients in hospitals in the last 14 days?

– Are there spikes in the number of deaths reported directly to cremation and burial grounds?

– Is there any rise in the emergence of new Covid cases in the last 14 days in different areas of the city, while keeping the sample collection size at a level not below the average sampling size of the last 14 days?

– A minimum 40% of the ICU and hospital bed capacity should be available during this period.

– During the relaxed lockdown period, there shall be an area-wise, well laid out sampling and testing policy in place for the whole city. The policy plan shall have a pre-fixed minimum sample size threshold, and will lay focus both on the vulnerable category and the random sampling process.

– Is there a decline in the ILI (influence-like illness) and SARI (severe acute respiratory infections) cases identified in both active and passive surveillance during the relaxed lockdown period?

– Are there sufficient institutional quarantine facilities available on a ready-to-move basis?

– Is there a sufficient inventory of protective equipment for the health care workers, civil administration and the general public?

The above strategic parameters need to be benchmarked in percentage terms or absolute numbers, based on the baseline data, which the Medical and Health Department has collected since the emergence of the first positive case.

After the benchmarking of the above parameters, a dynamic policy framework may be created indicating the pointers for easing or pulling back of the restrictions depending on the slippage of the city on one or more of the above set of criteria.

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The decision making would remain dynamic considering the nature of the activities being regulated. Governments will have to exercise enough caution while easing or imposing restrictions for at least another six months to avoid any further outbreaks.

All said, the key to fight against Covid remains the extensive use of masks, sanitisation, hand washing, early reporting to the hospital and a massive awareness campaign. For a long time to come, we will have to reduce our points of physical interaction to the best extent possible.

Ajitabh Sharma, IAS, is Nodal Officer COVID, Jaipur City. This article is based on actual field experience. Views are personal

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